Provider Demographics
NPI:1871118638
Name:DEBALKE, YAFET BEKELE
Entity type:Individual
Prefix:
First Name:YAFET
Middle Name:BEKELE
Last Name:DEBALKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 S SABLE BLVD UNIT H
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4617
Mailing Address - Country:US
Mailing Address - Phone:720-338-0315
Mailing Address - Fax:
Practice Address - Street 1:1183 S SABLE BLVD UNIT H
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4617
Practice Address - Country:US
Practice Address - Phone:720-338-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO061700870343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)